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Individual

ELISA VENGALIL

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
2230 COTTMAN AVE, PHILADELPHIA, PA 19149-1230
(215) 685-6769
Mailing address
2230 COTTMAN AVE, PHILADELPHIA, PA 19149-1230

Taxonomy

Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
MD485699
PA
390200000X
Student in an Organized Health Care Education/Training Program

Other

Enumeration date
04/01/2021
Last updated
06/19/2024
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